Provider Demographics
NPI:1962522755
Name:GUERRERO, JORGE (PT)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11531 WHISPER BREEZE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3524
Mailing Address - Country:US
Mailing Address - Phone:210-884-6230
Mailing Address - Fax:210-308-5557
Practice Address - Street 1:2210 NW MILITARY HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1815
Practice Address - Country:US
Practice Address - Phone:210-308-5558
Practice Address - Fax:210-308-5557
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1918013Medicaid
9312107OtherAETNA
TX8T7711OtherBCBS
TX1918013Medicaid